Colorectal cancer (CRC) is the 3rd leading cause of cancer death among Hispanic women and ties with prostate cancer as the 2nd deadliest cancer among Hispanic men. A key and modifiable way to decrease mortality from CRC among Hispanics is to increase their rates of CRC screening and early detection of CRC. Unfortunately, the majority of Hispanics do not get screened. All the more troubling is that CRC screening rates are even low for individuals who seek routine medical care. Prior to developing interventions to increase CRC screening in Hispanics, the factors that are barriers and facilitators to screening among Hispanics need to be identified. To that end, the proposed R21 will identify barriers and facilitators to CRC screening among urban Hispanics treated in three primary practice settings, involving over 35 full-time physicians, located in East Harlem, New York. This proposal directly addresses the priorities identified by NCI for social, behavioral, and health services research in colorectal cancer. The proposal focuses on behavioral models that can guide interventions to increase the use of CRC screening in urban Hispanics, cultural considerations are a theme throughout, and the research team is interdisciplinary. The specific aims are: 1) To identify barriers and facilitators to endoscopic CRC screening in urban Hispanics (Dominicans, Mexicans and Puerto Ricans) treated in a primary care practice and 2) To investigate health care, health promotion, and cultural factors associated with Hispanics': a) stage of readiness to undergo endoscopic CRC screening; and b) endoscopic CRC screening adherence. The study will also explore if there are intra-Hispanic differences (i.e., differences among Dominicans, Mexicans, and Puerto Ricans), for the factors associated with stage of readiness to undergo endoscopic CRC screening and endoscopic CRC screening adherence. There will be two phases to the study. Each of the two study phases will use a different approach to data collection and analysis. The first phase will use focus group methodology with six focus groups comprised of up to 10 Hispanics in each group. Qualitative analyses of the data from the focus groups will identify barriers and facilitators of CRC screening among Hispanics and suggest revisions to the survey that will be used for the 2nd study approach. The second phase will use a cross-sectional survey of 300 Hispanics men and women), over the age of 50 at average risk for CRC. The results of the quantitative analyses with the data from the study's cross-sectional survey will indicate health care, health promotion, and cultural factors associated with Hispanics' stage of readiness to undergo endoscopic CRC screening and endoscopic CRC screening adherence. The results from this second study approach will also suggest if there are intra-Hispanic differences in the factors identified as barriers and facilitators to CRC screening. Lay Summary: The proposed study seeks to investigate the barriers and facilitators of CRC screening among Hispanics. The study results will lead to the development of intervention materials to increase CRC screening among diverse Hispanics based on the factors that are most relevant to them. Interventions to increase CRC screening in this rapidly growing minority group could increase their rates of CRC screening and thereby decreased their mortality from CRC. [unreadable] [unreadable] [unreadable] [unreadable]